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Medicare: Just the Facts!

Misinformation about Medicare and the Affordable Care Act is widespread and increasing as the election nears.  Below, we try to dispel misinformation and base discussions on a factual foundation.  Spread the word. Help set the record straight!

The Fact

Here's Why

The Affordable Care Act does NOT cut Medicare for beneficiaries.

The Affordable Care Act[1] achieves savings in the Medicare program through a series of payment reforms, service delivery innovations, and increased efforts to reduce fraud, waste, and abuse. The actual projected reduction in Medicare spending (the infamous $716 billion) is largely a result of reducing overpayments to private Medicare plans that have been paid more than traditional Medicare.

[1] The health care reform law: Pub.L.111-148, the Patient Protection and Affordability Care Act of 2010 (PPACA), on March 23, 2010, and Pub. L. 111-152, the Health Care and Education Reconciliation Act of 2010 (HCERA), on March 30, 2010.

The Affordable Care Act actually extends the life of the Medicare trust fund by about a decade.

Saving on wasteful overpayments now means there will more future funds for legitimate coverage. ACA extends Medicare's solvency.

See: CBO March 20, 2010; Joint Committee on Taxation Revenue Estimates, JCX-17-10 (March 20, 2010).

The Affordable Care Act is not a government takeover.  In fact, ACA will provide coverage through private insurance.

ACA allows individual states to set up “exchanges,” or marketplaces, where private insurance companies will compete to offer affordable health coverage for those who do not have and cannot afford it currently. People who have insurance can keep their plans, but will have more consumer protections as a result of ACA – including a ban on coverage denials due to pre-existing conditions.

The Affordable Care Act lowers the deficit.

The Congressional Budget Office (CBO) has estimated that ACA will actually reduce the deficit by over $130 billion in the next decade through a series of payment and quality reforms. CBO also reported that repealing ACA would increase the deficit.

The Affordable Care Act improves benefits in Medicare.

ACA outlines new benefits and improvements to the Medicare program, including eliminating the Donut Hole coverage gap for prescription drugs, adding an annual Wellness visit, and increasing free preventive services for beneficiaries.

There are no “death panels” in the Affordable Care Act.  The payment board set up by ACA cannot cut benefits or make health care decisions for beneficiaries.

The Independent Payment Advisory Board (IPAB) is prohibited under the law from restricting Medicare benefits, modifying eligibility, or increasing Medicare beneficiary premiums and cost-sharing, including deductibles, coinsurance, and co-payments.

Americans will not be required to drop their current insurance.

The law protects the ability of families and employers to keep their current health plans. In fact, most of the 133 million Americans with health coverage through large employers will maintain their coverage.  However, they, and all people with health insurance, will be included in ACA's consumer protections.

The Affordable Care Act did NOT change the calculation of the Part B premium at all.

The Balanced Budget Act of 1997 permanently set standard Part B premiums to cover 25% of projected per capita Part B program costs for beneficiaries aged 65 and older.  If projected Part B costs increase or decrease, the premium rises or falls.  ACA didn’t change this.

There is no way to predict the premium for future years, as they are based around total costs and are tied to the cost-of-living. The Centers for Medicare & Medicaid Services (CMS) announces the Part B premiums for the next year at the end of the prior year.

Monthly Medicare Part B premiums may increase, may stay the same, or may even decrease, depending on formulas IN PLACE BEFORE ACA.

The Affordable Care Act expressly bars undocumented immigrants from accessing health coverage or assistance.

ACA requires the Secretary of Health and Human Services (HHS) to establish a program that will determine whether individuals are lawfully present in the United States if they apply for coverage in the exchanges, or for subsidies to help pay for insurance.


Affordable Care Act Provides Big Savings for Medicare Beneficiaries

Last week, the Department of Health and Human Services (HHS) released new data showing that 5.6 million Medicare beneficiaries have saved $4.8 billion on prescription drugs since the Affordable Care Act (ACA) was signed into law. [1]

So far this year, over 2 million beneficiaries have saved an average of $657 per person when they reach the “Donut Hole”, which ACA will fully close by 2020. In 2013, beneficiaries who hit the Donut Hole will enjoy discounts of 53% on covered brand name drugs, and 21% savings on generic drugs- real relief for people who rely on Medicare.

People with Medicare are also benefiting from key preventive services with no cost-sharing added by ACA. In 2012 alone, nearly 21 million beneficiaries have received at least one free preventive service, including mammograms and colorectal screenings. Before ACA, cost-sharing on critical preventive services meant fewer people took advantage of them. Now, those services are helping people stay healthy and informed without imposing barriers of cost on beneficiaries.

Future Drug Savings Would be Eliminated if ACA is Repealed

Families who rely on Medicare have seen real improvements in the Medicare program – including the savings on prescription drugs – since ACA was signed.  However, all those improvements and savings would be eliminated if, as some policymakers and candidates have promised, the ACA is repealed. Repeal would mean that the Donut Hole once again widens and that the cost of prescription drugs increases for beneficiaries. In addition, cost-sharing on important preventive services would be imposed, creating barriers to access for many families.

The affordable Care Act is making real progress for millions of families who struggle with health care costs. Repeal would increase the burden on people with Medicare, while ignoring the real issue of rising overall health care costs. The Affordable Care Act is a critical step forward to lower costs and improve care and outcomes for Medicare beneficiaries, and all Americans.



Jimmo v. Sebelius "Improvement Standard" Case Update

The Center for Medicare Advocacy continues to work to effectuate terms of the settlement in Jimmo v. Sebelius (No. 11-cv-17 (D.Vt.), filed January 18, 2011).  The media have quickly picked up the story after Robert Pear ran an exclusive article in The New York Times last week, and beneficiaries, advocates, and other organizations with an interest in the clarification of coverage under the settlement have been contacting the Center daily, as well as reaching out to media themselves.  For example, the National Parkinson Foundation sent a letter praising the decision to The New York Times, citing a study they co-authored which supports that improved access to skilled maintenance care will result in preventing or shortening hospital stays, thus saving the Medicare program money on more intensive, expensive care.

See the full letter at:

See the Parkinson Foundation study at:




[1] Department of Health and Human Services, Press Release. Available at

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